Fibroids and fertility

Document Type : Original Article

Author

Assisted Conception Unit, Guy s and St Thomas Hospitals NHS Foundation Trust, 11th Floor, Tower Wing, Guy s Hospital Great Maze Pond, London SE1 9RT, UK

Abstract

Uterine fibroids are the most common pelvic tumours in reproductive age women. Although most women with fibroids are fertile, fibroids may interfere with fertility secondary
to anatomical distortion and alterations to the uterine environment. Whilst fibroids are
associated with infertility in 5-10% of cases, they are estimated to be the sole cause of
infertility in 2-3% of cases.
Observational epidemiological studies aimed at elucidating the relationship between fibroids and infertility are inconclusive due to methodological limitations. However, two
main pieces of clinical evidence support the opinion that fibroids interfere with fertility.
Firstly, in IVF treatment, women with fibroids have an adverse pregnancy outcome. Available evidence suggests that submucosal and intramural fibroids interfere with fertility in decreasing order of importance and subserosal fibroids have no impact on fertility. Secondly,
although randomised studies are lacking, myomectomy appears to increase the pregnancy
rate in women with submucosal fibroids and possibly in women with intramural fibroids.
Keywords fibroids; myomas; leiomyomas; infertility; IVF; miscarriage; myomectomy; laparoscopy; hysteroscopy; uterine artery embolisation.

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